Calidad de la voz cantada en sopranos. Influencia del texto y el acompañamiento musical en el canto de ópera / quality of the singing voice in sopranos. Influence of the text and the musical accompaniment in the opera singing

Introducción y objetivos La voz cantada en canto de ópera utiliza diferentes mecanismos técnicos con finalidad artística. Queremos determinar si la calidad del sonido cantado se ve afectada por un trabajo consciente sobre el acompañamiento musical y el texto. Analizamos la señal acústica y la percepción subjetiva. La altura de tono estudiada en voz de soprano es el La4 (880Hz) sobre la vocal /a/. Hemos elegido un tono y una vocal que pueden generarse mediante diferentes estrategias en cuanto a los ajustes fonorresonanciales. Materiales y métodosHemos realizado un estudio prospectivo con 20 sopranos, libres de enfermedad, que han cantado una frase del aria «Deh, vieni non tardar» y otra del aria «Dove sono i bei momento». de la ópera Le nozze di Figaro, compuesta por W.A. Mozart. En primer lugar, se grabó cada frase cantada de modo espontáneo y una segunda vez, tras un trabajo propuesto sobre el contenido del texto y aspectos musicales del acompañamiento como son: ritmo, armonía, textura y dirección de la frase. Las participantes prolongaron la emisión del La4 algo más de 3s manteniendo el contexto de la frase. La señal acústica ha sido analizada mediante el programa PRAAT y se ha utilizado un cuestionario de la escala visual analógica (EVA) para recoger las percepciones subjetivas Resultados La media de edad fue de 36±11 años (rango entre 20 y 58), la media de años cantando fue de 17±12 años (rango entre 3 y 35). No se han encontrado diferencias estadísticamente significativas, aunque sí se aprecia una mejoría de la EVA en la segunda frase tras la intervención. Conclusiones Los parámetros de análisis acústico son estables y la EVA tiende a mejorar cuando se realiza un trabajo de toma de conciencia del texto y el acompañamiento instrumental. (AU)

Introduction and objectives Opera singing voice uses different technical tools for artistic purposes. We want to define if the quality of the sung sound is affected by an aware work on the musical accompaniment and the text. We analyze the acoustic signal and the subjective perception. The pitch studied in the soprano voice is A4 (880Hz) with the vowel /a/. We have chosen a tone and a vowel that can be generated by different strategies in terms of phonoresonance adjustments. Materials and methods We have carried out a prospective study with 20 sopranos, without voice pathology, who have sung a phrase from the aria Deh, vieni non tarda and another from the aria Dove sono i bei momenti from the opera Le nozze di Figaro, by W.A. Mozart. First, each phrase sung spontaneously was recorded and then a second time, after a proposed work on the content of the text and musical aspects of the accompaniment such as: rhythm, harmony, texture and direction of the phrase. The participants prolonged the emission of the A4 for more than three seconds, maintaining the context of the sentence. The acoustic signal has been analyzed using the PRAAT program and a VAS (Visual Analogue Scale) questionnaire has been used to collect subjective perceptions. Results The mean age was 36±11 years (range between 20 and 58) and the mean number of years singing was 17±12 years (range between 3 and 35). No statistically significant differences were found, although an improvement in the VAS was seen in the second sentence after the intervention. Conclusions The acoustic analysis parameters are stable, and the VAS tends to improve when an awareness of the text and the instrumental accompaniment is carried out. (AU)

Quality of the singing voice in sopranos. Influence of the text and the musical accompaniment in the opera singing.

INTRODUCTION AND OBJECTIVES: Opera singing voice uses different technical tools for artistic purposes. We want to define if the quality of the sung sound is affected by an aware work on the musical accompaniment and the text. We analyse the acoustic signal and the subjective perception. The pitch studied in the soprano voice is A4 (880 Hz) with the vowel /a/. We have chosen a tone and a vowel that can be generated by different strategies in terms of phonoresonance adjustments. MATERIALS AND METHODS: We have carried out a prospective study with 20 sopranos, without voice pathology, who have sung a phrase from the aria Deh, vieni non tarda and another from the aria Dove sono i bei momenti from the opera Le nozze di Figaro, by W.A. Mozart. First, each phrase sung spontaneously was recorded and then a second time, after a proposed work on the content of the text and musical aspects of the accompaniment such as: rhythm, harmony, texture and direction of the phrase. The participants prolonged the emission of the A4 for more than three seconds, maintaining the context of the sentence. The acoustic signal has been analysed using the PRAAT programme and a VAS (Visual Analogue Scale) questionnaire has been used to collect subjective perceptions. RESULTS: The mean age was 36 ± 11 years (range between 20 and 58) and the mean number of years singing was 17 ± 12 years (range between 3 and 35). No statistically significant differences were found, although an improvement in the VAS was seen in the second sentence after the intervention. CONCLUSIONS: The acoustic analysis parameters are stable, and the VAS tends to improve when an awareness of the text and the instrumental accompaniment is carried out.

Clinical-radiological Correlation in Temporal Bone Fractures.

INTRODUCTION: The diagnosis of temporal bone fractures (TBF) is based on radiological imaging. The most widely used classification divides fractures into longitudinal, transverse, and mixed. In recent years, other classifications have emerged to better predict clinical manifestations. OBJECTIVES: To review computed tomography (CT) images of TBF, define their radiological pattern, and study the concordance of the observed findings with those described in the radiological report. To analyse the association between fracture types and clinical findings. To study the impact of mastoid pneumatization on fracture characteristics. METHODS: Retrospective study of 110 TBF diagnosed with CT between January 2016 and May 2019. RESULTS: Fifty-two transverse (47%), 34 longitudinal (30%), and 19 mixed fractures (17%) were identified with good interobserver agreement (k = .637). Longitudinal fractures were associated with conductive hearing loss (P < .001) and transverse fractures with sensorineural hearing loss (P = .005). Of the fractures, 8.2% showed involvement of the otic capsule, and were associated with sensorineural hearing loss (P < .001), facial paralysis (P = .019) and vertigo (P= .035). Fractures were more frequent in cases of greater pneumatization, and the involvement of the otic capsule in cases of very good pneumatization (P = .024). CONCLUSIONS: The traditional classification of TBF is reproducible. Its association with clinical findings improves when the involvement of the otic capsule is also analysed. Mastoid pneumatization is not a protective factor for TBF or for involvement of the otic capsule.

Correlación clínico-radiológica de las fracturas de hueso temporal / Clinical-radiological correlation in temporal bone fractures

Introducción: El diagnóstico de las fracturas del hueso temporal (FHT) se basa en la imagen radiológica. La clasificación más utilizada divide las fracturas en longitudinales, transversales y mixtas. En los últimos años han surgido otras clasificaciones con el objeto de predecir mejor las manifestaciones clínicas.ObjetivosRevisar las imágenes de tomografía computarizada (TC) del hueso temporal, definir su patrón radiológico según la clasificación tradicional y estudiar la concordancia interobservador de los hallazgos encontrados con los descritos en el informe radiológico. Analizar la asociación entre los tipos de fractura y los hallazgos clínicos. Estudiar el impacto de la neumatización mastoidea en las características de la fractura.Materiales y métodosEstudio retrospectivo de 110 FHT diagnosticadas mediante TC entre enero de 2016 y mayo 2019.ResultadosSe identificaron 52 fracturas transversales (47%), 34 longitudinales (30%) y 19 mixtas (17%) con buena concordancia interobservador (k = 0,637). Las fracturas longitudinales se asociaron con hipoacusia de transmisión (p < 0,001) y las transversales con hipoacusia neurosensorial (p = 0,005). El 8,2% de las fracturas presentaron afectación de cápsula ótica y se asociaron con hipoacusia neurosensorial (p < 0,001), parálisis facial (p = 0,019) y vértigo (p = 0,035). Las fracturas fueron más frecuentes en los casos de mayor neumatización, y la afectación de cápsula ótica en casos de muy buena neumatización (p = 0,024). (AU)

Introduction: The diagnosis of temporal bone fractures (TBF) is based on radiological imaging. The most widely used classification divides fractures into longitudinal, transverse, and mixed. In recent years, other classifications have emerged to better predict clinical manifestations.ObjectivesTo review computed tomography (CT) images of TBF, define their radiological pattern, and study the concordance of the observed findings with those described in the radiological report. To analyse the association between fracture types and clinical findings. To study the impact of mastoid pneumatization on fracture characteristics.MethodsRetrospective study of 110 TBF diagnosed with CT between January 2016 and May 2019.ResultsFifty-two transverse (47%), 34 longitudinal (30%), and 19 mixed fractures (17%) were identified with good interobserver agreement (k = .637). Longitudinal fractures were associated with conductive hearing loss (p < .001) and transverse fractures with sensorineural hearing loss (p = .005). Of the fractures, 8.2% showed involvement of the otic capsule, and were associated with sensorineural hearing loss (p < .001), facial paralysis (p = .019) and vertigo (p = .035). Fractures were more frequent in cases of greater pneumatization, and the involvement of the otic capsule in cases of very good pneumatization (p = .024). (AU)

La voz cantada / The singing voice

La voz cantada representa un subgrupo especial dentro del campo de la voz. Además de caracterizarse por aspectos diferenciales en cuanto a la fisiología, los pacientes-cantantes son con frecuencia un reto para los otorrinolaringólogos. Esto es debido probablemente a que la formación específica en nuestra especialidad en el campo de la voz no ha tenido el protagonismo que han tenido otras áreas. Pero además, en el caso de los cantantes, es imprescindible la existencia de una gran empatía en la relación médico-paciente que aquí, como en otras muchas ocasiones, forma parte del efecto terapéutico. Para lograrla, es imprescindible que el otorrinolaringólogo sepa qué es un cantante, cómo se forma, cómo se expresa, y qué patología le afecta. Esta revisión pretende dar una visión general de la fisiopatología de la voz cantada desde el doble aspecto científico y artístico, que, en el caso del canto, van indefectiblemente unidos (AU)

Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist. The reason for this is probably that the field of voice has not received as much attention as others in our speciality. Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed. This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked (AU)

Validación de la versión en español del índice de incapacidad vocal (S-VHI) para el canto / Validation of the Spanish version of the voice handicap index for vocal singing (SVHI)

En los cuestionarios que existen actualmente en español para valorar la repercusión en la calidad de vida de la patología de la voz no hay preguntas que hagan referencia específicamente a la voz cantada. Se exponen los resultados de la validación del índice de incapacidad vocal para voz cantada (S-VHI) en español. Material y métodos: Se tradujo al español la versión validada en inglés. El cuestionario fue contestado por 29 cantantes que aquejaban algún tipo de dificultad específica relacionada con la voz cantada y 81 cantantes sanos. Resultados: Se encontró una fiabilidad test-retest buena (r=0,63, p=0,000). Respecto a la correlación ítem-total se encontró que todos los ítems individuales muestran altas correlaciones. Se hallaron correlaciones significativas entre la severidad de la puntuación de la autovaloración de la voz hecha por el cantante y las puntuaciones totales del S-VHI (r=0,52, p=0,000). Se demostraron diferencias significativas entre el grupo de cantantes con disfonía y el grupo control en las puntuaciones del S-VHI (ANOVA, F=10,9, p< 0,002). Conclusiones: La versión traducida al español del cuestionario S-VHI es una herramienta validada, con una correcta consistencia interna y fiabilidad. La puntuación media del S-VHI en una población de cantantes sanos es de un 20% de la puntuación máxima posible del cuestionario, muy por encima de la puntuación media en una población sana para la voz hablada determinada con el VHI-30 (AU)

In the questionnaires that currently exist in Spanish to assess the impact on quality of life of voice pathology, there are no questions that refer specifically to the singing voice. We present the results of the validation of the Singing Voice Handicap Index (SVHI) in Spanish. Materials and methods: The SVHI was translated into Spanish from the validated version in English. The questionnaire was completed by 29 dysphonic singers and 81 healthy singers. Results: There was good test-retest reliability (r=0.63, p=0.000). Regarding the item-total correlation, it was found that all samples had high correlations on individual items. Significant correlations were found between the severity of the score of the voice self-rated by the singer and the total scores of the SVHI (r=0.52, p=0.000). There were significant differences between the group of singers with dysphonia and the control group in the SVHI scores (ANOVA, F=10.9, p <0.002). Conclusions: The Spanish version of the translated SVHI questionnaire is a validated tool with proper internal consistency and reliability. The average score of the SVHI singers in a healthy population is 20% of the maximum possible questionnaire score, well above the average score in a healthy population for the spoken voice with the 30-item specific VHI (AU)

[Validation of the Spanish version of the voice handicap index for vocal singing (SVHI)]. / Validación de la versión en español del índice de incapacidad vocal (S-VHI) para el canto.

UNLABELLED: In the questionnaires that currently exist in Spanish to assess the impact on quality of life of voice pathology, there are no questions that refer specifically to the singing voice. We present the results of the validation of the Singing Voice Handicap Index (SVHI) in Spanish. MATERIALS AND METHODS: The SVHI was translated into Spanish from the validated version in English. The questionnaire was completed by 29 dysphonic singers and 81 healthy singers. RESULTS: There was good test-retest reliability (r=0.63, p=0.000). Regarding the item-total correlation, it was found that all samples had high correlations on individual items. Significant correlations were found between the severity of the score of the voice self-rated by the singer and the total scores of the SVHI (r=0.52, p=0.000). There were significant differences between the group of singers with dysphonia and the control group in the SVHI scores (ANOVA, F=10.9, p <0.002). CONCLUSIONS: The Spanish version of the translated SVHI questionnaire is a validated tool with proper internal consistency and reliability. The average score of the SVHI singers in a healthy population is 20% of the maximum possible questionnaire score, well above the average score in a healthy population for the spoken voice with the 30-item specific VHI.

[The singing voice]. / La voz cantada.

Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist. The reason for this is probably that the field of voice has not received as much attention as others in our speciality. Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed. This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked.

[CSF fistulae following surgery for cerebellopontine angle tumours and their relationship with the body mass index]. / Fístulas de LCR tras la cirugía de tumores del ángulo pontocerebeloso y su relación con el índice de masa corporal.

INTRODUCTION: The most frequent complication after vestibular schwannoma surgery is cerebrospinal fluid (CSF) fistula. MATERIAL AND METHODS: Retrospective study of 170 patients who had vestibular schwannoma (163) or other tumours in the cerebello pontine angle (CPA) (7). Resection was carried out using different approaches: retrosigmoid (66%), translabyrinthine (24%), middle cranial fossa (5%) and others (5%). We studied the day of onset, location and treatment of the CSF leaks, and the influence of demographic, radiological and clinical variables, including Body Mass Index. RESULTS: 27 patients developed a CSF fistula (15.9%): 15 were incisional (8.8%), 8 patients developed CSF rhinorrhea (4.7%), 1 CSF otorrhea (0.6%) and 3 a combination of the above (1.8%). We controlled 11 CSF fistulae with bed rest and compressive dressings (6.5%), 7 required lumbar drainage (4.1%), 2 lumbar drainage and wound closure with local anaesthesia (1.2%) and 7 patients required returning to the operating room under general anaesthesia (4.1%). There was not a significant relationship between the apparition of CSF and tumour size, type of approach, age or body mass index (BMI). CONCLUSIONS: Despite the great development and new surgical techniques, CSF fistulae are still a frequent complication after VS surgery. There might be other aetiological factors such as intracranial pressure. There was no significant relationship between CSF fistula and BMI. Adequate management and early conservative measures led to reduced reintervention rates of less than 5% in all patients.

Fístulas de LCR tras la cirugía de tumores del ángulo pontocerebeloso y su relación con el índice de masa corporal / CSF fistulae following surgery for cerebellopontine angle tumours and their relationship with the body mass index

Introducción: La complicación más frecuente tras la cirugía del schwannoma vestibular (SV) es la fístula de líquido cefalorraquídeo. Métodos: Estudio retrospectivo de 170 pacientes intervenidos por SV (163) y otros tumores del ángulo pontocerebeloso (7). La resección se realiza por las vías retrosigmoidea (66%), translaberíntica (24%), fosa media (5%) y otras (5%). Se estudiaron día de aparición, localización, tratamiento e influencia de variables demográficas, clínicas (incluido el índice de masa corporal [IMC]) y radiológicas. Resultados: Se desarrolló fístula de líquido cefalorraquídeo (LCR) en 27 pacientes (15,9%), de las cuales 15 fueron incisionales (8,8%), 8 fueron rinolicuorreas (4,7%), 1 fue otolicuorrea (0,6%) y 3 fueron una combinación de éstas (1,8%). Se controlaron 11 fístulas con medidas conservadoras (6,5%), 7 pacientes mediante colocación de drenaje lumbar (4,1%), 2 pacientes precisaron drenaje lumbar y cierre con anestesia local (1,2%) y 7 pacientes requirieron reintervención bajo anestesia general (el 4,1% del total). No se demuestra relación significativa entre la aparición de las fístulas de LCR y la vía de abordaje, el tamaño tumoral, la edad ni el IMC. Conclusiones: A pesar de los avances técnicos, la fístula de LCR continúa siendo una complicación frecuente tras la cirugía del SV, no habiéndose desarrollado una técnica que garantice su desaparición. Podría haber otros factores implicados en su etiología, como la presión intracraneal. No se ha demostrado una relación entre las fístulas de LCR y el IMC. El empleo precoz de medidas conservadoras nos ha permitido reducir la tasa de reintervenciones bajo anestesia general a cifras inferiores al 5% de todos los pacientes intervenidos (AU)

Introduction: The most frequent complication after vestibular schwannoma surgery is cerebrospinal fluid (CSF) fistula. Material and methods: Retrospective study of 170 patients who had vestibular schwannoma (163) or other tumours in the cerebello pontine angle (CPA) (7). Resection was carried out using different approaches: retrosigmoid (66%), translabyrinthine (24%), middle cranial fossa (5%) and others (5%). We studied the day of onset, location and treatment of the CSF leaks, and the influence of demographic, radiological and clinical variables, including Body Mass Index. Results: 27 patients developed a CSF fistula (15.9%): 15 were incisional (8.8%), 8 patients developed CSF rhinorrhea (4.7%), 1 CSF otorrhea (0.6%) and 3 a combination of the above (1.8%). We controlled 11 CSF fistulae with bed rest and compressive dressings (6.5%), 7 required lumbar drainage (4.1%), 2 lumbar drainage and wound closure with local anaesthesia (1.2%) and 7 patients required returning to the operating room under general anaesthesia (4.1%). There was not a significant relationship between the apparition of CSF and tumour size, type of approach, age or body mass index (BMI). Conclusions: Despite the great development and new surgical techniques, CSF fistulae are still a frequent complication after VS surgery. There might be other aetiological factors such as intracranial pressure. There was no significant relationship between CSF fistula and BMI. Adequate management and early conservative measures led to reduced reintervention rates of less than 5% in all patients (AU)

Pharyngeal cancer prevention: evidence from a case--control study involving 232 consecutive patients.

The aim of this study was to determine risk factors for pharyngeal cancer and to propose 10 result-based preventive measures. It was a case-control study conducted in Madrid, Spain, with 232 consecutive patients diagnosed between January 1 1990 and December 31, 1995, sex- and age-matched with 232 control individuals with no oncological disease or history. By means of an interviewer-administered questionnaire, seven different epidemiological areas were surveyed, namely: (1) sociodemographic variables, (2) familial all-site cancer history, (3) medical history, (4) lifestyle (habits), (5) diet, (6) occupational exposure, and (7) non-occupational exposure. Of the great number of factors within each epidemiological area, the following were found to be risk factors after adjustment for tobacco smoking and alcoholic beverage drinking: (1) tobacco smoking, (2) alcoholic beverage drinking, (3) low and low-middle socioeconomic background, (4) low educational level, (5) rural milieu, (6) working, or having worked, as a manual worker in agriculture, (7) working, or having worked as a manual worker in building industry, (8) having an upper aerodigestive tract cancer familial history, (9) having a medical history of alcholism, low weight/malnutrition, gastroesophageal reflux or chronic obstructive bronchopneumonia, (10) low dietary intake of fruit, fruit juice, uncooked vegetables, dietary fibre-containing foods, fish and milk and dairy products, (11) high dietary intake of meat and fried foods, (12) deficient oral and dental hygiene, (13) abuse of black coffee, (14) abuse of 'carajillo' (a typical Spanish drink composed of black coffee and flambéed brandy), (15) occupational exposure to pesticides, solvents and dust of different origins. On the basis of our results and those reported by other authors, we put forward 10 measures for the prevention of pharyngeal cancer. However, due to the small size of the nasopharyngeal cancer subsample (n = 35, 15.08 per cent), our results as well as the preventive measures are to considered as referring uniquely to oropharyngeal and hypopharyngeal cancers. In addition, from descriptive statistical data inspection one can conclude that nasopharyngeal cancer is likely to bear risk factors different from those for oropharyngeal and hypopharyngeal cancers, thus nasopharyngeal cancer warrants specific epidemiological investigation with a sufficiently large patient sample.